202012-V15N2 The Indonesia Journal of Public Health

THE RELATIONSHIP OF KNOWLEDGE, EXPOSURE TO SUNLIGHT, AND CALCIUM INTAKE WITH THE RISK OF OSTEOPOROSIS Erliza Anggraini Firdaus1 , Bambang Wirjatmadi2 1 Study Program of Public Health, Faculty of Public Health, Airlangga University, Surabaya, Indonesia 2 Department of Health Nutrition, Faculty of Public Health, Airlangga University, Surabaya, Indonesia Correspondence Address: Erliza Anggraini Firdaus Email: [email protected] Email: ABSTRACT Osteoporosis is a bone disease causing decreased bone density. It often occurs to elderly women. At the age of 50- 80 years, 23% Indonesian women were at risk of osteoporosis, and this number would increase to 53% at the age of 70-80 years. This study aimed to identify the relationship of knowledge, calcium intake and exposure to sunlight habits with the risk of osteoporosis. This study used a cross-sectional design involed 26 members of the osteoporosis gymnastic group who had a low and high risk of osteoporosis. Data of food consumption were retrieved from 24-hour food recall. The chi-square analysis shows knowledge level had a relationship with risk of osteoporosis (p=0.047). Exposure to sunlight (p=0.437) and calcium intake (p = 0.187) had a relationship with the risk of osteoporosis. It can be concluded that the level of knowledge had a significant relationship with risk of osteoporosis. Knowledge variable is important to show the community mindset about the dangers and risks of osteoporosis. Therefore, education about osteoporosis is required. Keywords: osteoporosis, knowledge, calcium intake, exposure to sunlight habits. ABSTRAK Osteoporosis merupakan penyakit pada tulang yang ditandai dengan penurunan kepadatan tulang. Osteoporosis sering kita jumpai pada wanita lanjut usia atau lansia. Di usia 50 – 80 tahun wanita Indonesia berisiko osteoporosis sebesar 23% dan akan meningkat menjadi 53% pada usia 70 – 80 tahun. Tujuan dari penelitian ini adalah mempelajari hubungan pengetahuan dengan asupan kalsium dan kegiatan berjemur pada risiko osteoporosis. Penelitian ini termasuk jenis penelitian yang menggunakan rancangan studi cross sectional. Sampel penelitian ini adalah anggota kelompok senam osteoporosis yang memiliki risiko rendah dan tinggi terkena osteoporosis dengan jumlah 26 orang. Data Konsumsi pangan diperoleh melalui food recall 24 jam. Hubungan antara variabel dengan analisis Chi Square Tingkat pengetahuan dengan risiko osteoporosis p = 0,047. Kebiasaan berjemur dengan risiko osteoporosis p = 0,437 dan asupan kalsium pada resiko osteoporosis p = 0,187. Sehingga dapat disimpulkan bahwa tingkat pengetahuan yang memiliki hubungan signifikan terhadap risiko osteoporosis. Faktor pengetahuan sangat penting untuk menunjukkan pola pikir masyarakat mengenai bahaya dan risiko osteoporosis. Dan pemberian edukasi tentang osteoporosis sangat di perlukan. Kata Kunci : osteoporosis, pengetahuan, asupan kalsium dan kegiatan berjemur INTRODUCTION and social, psychological, and physical problems that interfere someone’s health Osteoporosis is a bone disease status (Cembrowicz, 2007). which reduces bone density. Decreased bone density occurs due to lower calcium According to the World Health levels. Osteoporosis is often called a \"silent Organization (WHO), there have been 200 disease\" because it does not cause million people suffering from osteoporosis symptoms apparent to osteoporosis worldwide. This number will increase every sufferers (Sefrina, 2015). It often occurs to year. In Indonesia, the Indonesian Ministry people in middle ages and above, especially of Health stated that the proportion of women. Osteoporosis can cause disability Indonesians at risk of osteoporosis was 19.7% in 2016 and would continue ©2020 IJPH. License doi: 10.20473/ijph.vl15il.2020.252-257 Received 29 May 2017, received in revised form 27 June 2017, Accepted 30 July 2017, Published online: December 2020

Erliza Anggraini Firdaus and Bambang Wirjatmadi, Relationship Between Knowledge...253 increasing each year. Further, it was stated METHODS that two out of five people in Indonesia were at risk of suffering from osteoporosis. This study was a comparative- At the age of 50-80 years, 23% Indonesian observational study using a cross-sectional women were at risk of osteoporosis, and the design. The study’s population was proportion would increase to 53% at the age members of the osteoporosis gymnastics of 70-80 years (Sefrina, 2015). According group at Dr. Soetomo District General to Pranoto (c2009) the Indonesian Hospital, Surabaya. The group was then population had a life expectancy of 64.71 divided into two sub-groups as the research years (1995-2000) and 67.68 years (2000- samples.Group I were the members of the 2005). With the increasing age, the risk of osteoporosis group with low risk of osteoporosis will increase. Five Indonesian osteoporosis, while Group II consisted of provinces, such as South Sumatra (27.7%), members with high risk of osteoporosis. Central Java (24.02%), Yogyakarta (23.5 This study employed a simple random %), North Sumara (22.82%), East Java sampling technique to collect 26 female (21.42%) and East Kalimantan (10.5%)had respondents. This study was conducted in a higher risk of osteoporosis. the parking lot of the Medical Rehabilitation Installation, Dr. Soetomo Muchtadi (2009) mentions the rate District General Hospital Surabaya from of bone formation may be normal, but there October 2016 – January 2017. will be an acceleration of bone resorption causing a decrease in bone mass. Bone To collect primary data, this study resorption can maintain calcium levels in used questionnaires given to the the blood. When people consumed foods respondents to identify their knowledge with low calcium levels, they are more about osteoporosis, calcium intake, and likely to suffer from osteoporosis. Some exposure to sunlight. Further, it utilized the risk factors that can increase the incidence data of monitored food consumption from a of osteoporosis include heredity, low intake 24-hour Food Recall. Meanwhile, this study of calcium and vitamin D3, smoking, lack obtained secondary data from the of sun exposure (Setiati, 2008). Further, description and profile of Dr. Soetomo these factors involve alcohol consumption, District General Hospital, Surabaya. fizzy and excessive caffeine consumption, lack of physical activity and exercise, The level of knowledge was menaoupose, chronic diseases and long- categorized into three:low (<60%), medium duration drug intake (Sefrina, 2015). (60% - 80%), and high (> 90%). Potassium consumption level was divided into two: Calcium and phosphate play an less (≤ 1200mg / day) and sufficient (≥1200 important role in bone formation. mg/day) (Andriani, 2012). While levels of Insufficient calcium intake will lead to exposure to sunlight were categorized into abnormal formation of bone and its tissue. two: enough (10-15 minutes per day) and Calcium can maintainbone tissue during less (<15 minutes per day) (Marmi, 2013). adulthood, especially for the elderly (Fatmah, 2010) and bone density. Other Data analysis were carried out in 2 nutrients that play a role in the bone ways: descriptive and analytical analyses. formation include vitamin D, vitamin C, Descriptive analysis presented the results in phosphorus, magnesium, and zinc (Sefrina, a frequency distribution table. Chi-square 2015). analysis was used to find out the relationship of knowledge, calcium intake, With the overview of osteoporosis and exposure to sunlight with the risk of incidence, this study aimed to identify the osteoporosis (α=0.05). relationship of knowledge, calcium intake and exposure to sunlight with the risk of osteoporosis.

254 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:252-257 RESULTS Table 2. Relationship between knowledge levels and risk of osteoporosis Table 1 shows 12 respondents at low among the respondents. risk of osteoporosis were aged 50-60 years (92.3%) and 6 of them with high risk of Level Low Risk High Risk osteoporosis (46.2%) were at the age of 61- Knowledge n% n% 70 years. Eight respondents with low risk -- 2 15.3 group had a high school education, and five Low 6 46.2 10 77 respondents with high risk had a junior high Medium 7 53.8 1 7.7 school education. Mostly, the respondents High 13 100 13 100 were housewives (53.8%). Total P 0.047 Education may affect calcium intake. It lies on the argument that says The analysis informs us that most of highly educated elderly will plan a healthy the respondents had high school and junior and nutritious diet for himself and his high school education. They mostly had family to meet his family’s nutritional moderate knowledge about osteoporosis. needs. According to Notoatmodjo (2011), The community knowledge and education knowledge is the result of knowing that level may suggest mindset about the occurs after people sense a certain object. dangers and symptoms of osteoporosis, and the state of work that might make them Table 1. Characteristics of respondents of overlook their health problems. The result osteoporosis gymnastics group at shows half of the respondents with low risk dr. soetomo district general had a moderate level of knowledge (53.8%). hospital in 2016. While, 10 respondents with high risk had a high level of knowledge (77%). Characteristics Low High Risk Risk n% Patterns of food consumption from Age n% one person to another can be different due 50 – 60 Years 5 38.5 to different levels of knowledge. Likewise, 61 – 70 Years 12 92.3 6 46.2 the elderly who have osteoporosis factors 1 7.7 2 15.3 tend to have different food consumption > 70 Years -- 13 100 patterns following their level of knowledge. Total 13 100 Someone who is knowledgable tend to Education 1 7.7 choose better quality foods. 1 7.7 5 38.5 Elementary -- 4 30.8 Generally, calcium is necessary for Junior High 8 61.5 1 7.7 the bone development. Osteoblasts add and High school 4 30.8 2 15.3 store calcium in bones, while osteoclasts Diploma -- 13 100 break down and excrete calcium in bones In Bachelors 13 100 particular cases, when the body lacks 7 53.8 calcium, calcium in the bones will be Total 4 30.8 6 46.2 released to meet the body's needs, thus Job 5 38.5 -- causing porous bones (Tandra, 2009). Old Housewife 2 15.3 people generally lack calcium which should Retiree -- at 1000 mg among people aged 19-50 years. Civil servant 1 7.7 -- People more than 51 years old even need Private 1 7.7 13 100 higher calcium intakes at 1200 mg employee 13 100 (Andriani, 2012). Someone’s physical Entrepreneur health will decrease in older ages. As a Total result, it may cause psychological and

Erliza Anggraini Firdaus and Bambang Wirjatmadi, Relationship Between Knowledge...255 social physical function disorders which eight respondents with low risk (61.5%) had can further lead to dependency on others sufficient exposure to sunlight, while 7 (Andriani, 2012). respondents with high risk (53.8%) had inadequate exposure to sunlight. Table 3. Relationship between calcium intake and risk of osteoporosis DISCUSSION among the respondents. The members of osteoporosis Calcium Intake Low Risk High gymnastics group at Dr. Soetomo District n% Risk General Hospital Surabaya mostly had a Less n% junior high school, high school, and <1200 mg 8 61.5 diploma education. Besides, they had Enough >1200 6 46.2 moderate knowledge about osteoporosis. mg 5 38.5 Total 13 100 7 53.8 Furthermore, food consumption that P 13 100 varies among people may be due to different 0.187 levels of knowledge. Likewise, the elderly could have different food consumption In the low risk group, 8 respondents patterns since exposure to information they (61.5%) had less than 1200 mg calcium obtained might be different too. intake per day. Seven respondents (53.8%) with high risk had a sufficient calcium People aged 19-50 years ideally intake at > 1200 mg per day. need 1000 mg calcium, while those more than 51 years old should have 1200 mg Table 4. Relationship between level of calcium intake (Andriani, 2012). Another exposure to sunlight and risk of mineral that plays an important role in osteoporosis among the bones is phosphorus. Consuming less or respondents. excessive food is also not good for the body. Food consumption discussed in this study Level of Low Risk High Risk explains about types and amount of daily Exposure to food consumption, as well as characteristics n %n% of the food consumers (Andriani, 2012). Sunlight 8 61.5 6 46.2 Enough 5 38.5 7 53.8 This study reveals that the level of Not enough 13 100 13 100 knowledge had a significant relationship with the risk of osteoporosis. Knowledge Total 0.431 can lead to an action, activity or behavior P (Kusumawati 2014). Elderly with good knowledge tend to maintain health Moreover, osteoporosis can be condition every day. According to prevented if people receive enough vitamin Notoatmodjo (2011), before adopting new D which comes from sunlight. People need behaviors, someone will experience a about ten-to-fifteen-minute sunlight sequential process starting from awareness exposure every day (Marmi, 2013). The (awareness), in which they realize a intensity of UVB (short ultraviolet waves) stimulus (object). In other words, sunlight is low at 07.00 AM and increases knowledge is necessary for investing in the following hours. At 11.00 AM, this healthy behavior. Some vulnerable groups intensity is relatively stable and high until with high risks of osteoporosis were those 14.00 PM. At 16.00 PM, it reaches the same who were menopause and , smokers. Also, intensity as at 07.00 AM. Exposure to low those were aged 30 to 40 years who had intensity of sunlight can facilitate vitamin D heredity, lack of exercise, history of certain intake (Setiati, 2008). The result explains drug consumption, and low intake of calcium and vitamin D. To prevent

256 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:252-257 osteoporosis, knowledge is the key factor the analysis shows there was no relationship that might trigger someone to consume between knowledge and exposure to healthy foods for bones, regulate a healthy sunlight. It may be due to the fact that lifestyle, and exercise regularly and support vitamin D can be absorbed from not only bone health. sunlight, but also foods and other supplements such as milk. The result has a Calcium intake in the elderly is very relevance with the fact that most of the important for bone strength to avoid respondents were retirees who maybe do osteoporosis. If calcium intake in bone not work outside and take a moment for decreases, bone density will decrease faster being exposed to sunlight in the morning. thereby leading to greater osteoporosis risks. Furthermore, vitamin D plays an This study also reveals that 53.8% important role in the process of calcium of the respondents had sufficient exposure absorption in the body (Sefrina, 2015). to sunlight. Most of them already knew the Older people who have more calcium and importance of exposure to sunlight since more exposure to sunlight will be less at risk vitamin D generated form sunlight of osteoporosis. contributes to the bone mineralization process in which the absorption of calcium Every day the respondents consumed occurs in the body (Tandra, 2009). A carbohydrates derived from whole grains previous meta-analysis study recommends (rice). Elderly are recommended to to give high doses of calcium intake (1200 consume less simple sugars and replace mg or more) and vitamin D intake (800 mg them with complex carbohydrates or more) to prevent osteoporosis contained in nuts and seeds as a source of (Witjaksono, 2012). energy and a source of fiber (Marmi, 2013). This result explains that most respondents The body needs calcium for consumed carbohydrates derived from metabolic processes. When the body lacks noodles once a month calcium, it will take calcium reserves in the (sometimes).Vegetable and animal protein bones. Apart from consuming high-calcium is required to fulfill 10% of the total calorie foods, people need to be concerned about needs per day (Andriani, 2012). However, vitamin D deficiency which will impact the repsondents rarely consumed animal bone metabolism seriously. protein. This study shows the respondents consumed meat, eggs, and other animal CONCLUSION protein food twice a week. Daily consumption of vegetables and fruits with The study’s respondents were high fiber was good enough. However, mostly aged 50-60 years, had high school excessive consumption of fiber may cause education, a moderate level of knowledge minerals and other nutrients to be absorbed about osteoporosis, worked as a housewife by the fibers, not by the body itself. or retiree, and had enough exposure to sunlight and good food intake. Knowledge Also, milk is important because of its had a significant relationship with risk of high calcium level is good for bones. This osteoporosis. Therefore, the hospital needs type of food can be an alternative for people to further educate the gymnastics group aged more than 51 years and requiring 1200 about the risks and dangers of osteoporosis mg calcium intake. to make them more alert about the issues. The group also needs to be more open to The analysis shows that there was a parties or management and willing to significant relationship between knowledge express complaints or problems related to and exposure to sunlight. Knowledge can be their health. manifested into actions or attitudes towards health and risk of osteoporosis. Early It is also highly recommended that prevention and treatment can be done further research could use a larger number through knowledge investment. However,

Erliza Anggraini Firdaus and Bambang Wirjatmadi, Relationship Between Knowledge...257 of samples and more variables to give more mengenal, mengatasi, dan representative findings. mencegah tulang keropos. Jakarta : REFERENCE PT. Gramedia Pustaka Utama. Andriani, M., Wirajarmadi, B., 2012. Witjaksono, F., 2012. Nutrisi pada Osteoporosis. Jakarta : RSCM Departemen Gizi FKUI. Peranan Gizi dalam Siklus Kehupan. Jakarta : Kencana Prenada Media Grup. Cembrowicz, 2007. Osteoporosis. 2th ed. London : Class publising. Fatmah, 2010. Gizi usia lanjut. Jakarta : Erlangga. Kusumawati, D., 2014. Gambaran Tingkat Pengetahuan Lansia Tentang Osteoporosis di Panti Wedha Dharma Bakti Surakarta. Karya Tulis Ilmiah. STIKES PKU Muhammadiyah Surakarta. Marmi, 2013. Gizi dalam Kesehatan Reproduksi. Yogyakarta : Pustaka Belajar. Muchtadi, D., 2009. Gizi anti penuaan dini. Bandung : Alfabeta, CV. Notoatmodjo, S., 2011. Kesehatan Masyarakat. Jakarta : Rineka cipta. Notoatmodjo, S., 2012. Metodelogi penelitian kesehatan. Jakarta : Rineka cipta. Pranoto, A., 2009. Osteoporosis secara umum. Diabetes and Nutrition Center, Dr Soetomo Hospital- Airlangga University Division of Endocrinology Metabolism, Department of Internal Medicine, Medical Faculty, Airlangga University. Sefrina, A., 2015. Osteoporosis the silent disease. Yogyakarta : rapha oitpada Publising. Setiati, S., 2008. Pengaruh Pajanan Sinar Ultraviolet B Bersumber di Sinar Matahari terhadap konsentrasi Vitamin D (25(OH)D) dan Hormon Paratiroit pada perempuan usia lanjut. Jurnal Kesehatan Masyarakat Nasional, 2(4), pp.147 – 15. Tandra, H., 2009. Segala sesutu yang anda ketahui tentanng osteoporosis

THE UTILIZATION OF GOLDEN PERIOD OF ISCHEMIC STROKE IN PATIENTS IN PRODUCTIVE AGES Vidya Tri Huttami1, Atik Choirul Hidajah1 1Epidemiology Department, Faculty of Public Health, Airlangga University, Surabaya, Indonesia Correspondence Address: Vidya Tri Huttami Email: [email protected] ABSTRACT The 2007 Basic Health Survey shows the highest number of deaths in Indonesia rural and urban areas was caused by stroke. In 2007-2013, the stroke prevalence in productive age increased up to 22‰. Stroke that attacks productive age can impair individual’s ability to do activities, and thus they might have family financial constraint. Disabilities can be prevented and minimized if patients utilize a golden period of an ischemic stroke. This study identified the utilization of golden period of ischemic stroke in patients and analyzed causes of delayed patient admission to the Neurology Clinic of Sidoarjo Hospital. This study was a descriptive study conducted to 39 post- stroke ischemic patients in productive ages under further therapy at the Neurology Clinic of Sidoarjo Hospital in 2016. The data were collected through interview from January-February 2017. The results present 62% of stroke ischemic patients utilized the golden period of a ischemic stroke. The average respondents' admission took 29.87±47.46 hours after patients experienced first stroke ischemic attacks (ranging from 1-168 hours). The respondents were admitted to the hospital late or >4.5 hours after the stroke attacks because most of them did not know stroke signs and symptoms. Therefore, hospitals or health care providers have to provide counseling service to patients and family members about stroke signs and symptoms, as well as the importance of early admission for treatment as soon as patient gets the first stroke attack. Keywords: utilization of the golden period, ischemic stroke, productive age. ABSTRAK Kematian tertinggi di wilayah pedesaan dan perkotaan Indonesia berdasarkan hasil Riskesdas Tahun 2007 disebabkan oleh stroke. Pada Tahun 2007-2013 prevalensi stroke usia produktif mengalami pengingkatan sebesar 22,2‰. Stroke yang menyerang usia produktif dapat menyebabkan terganggunya ekonomi keluarga dikarenakan kecacatan setelah terjadinya serangan stroke. Kecacatan dapat dicegah dan diminimalkan jika pasien memanfaatkan golden period stroke iskemik. Penelitian ini bertujuan untuk mengidentifikasi pemanfaatan golden period oleh pasien stroke iskemik dan untuk menganalisis penyebab terjadinya keterlambatan pasien datang ke rumah sakit. Penelitian ini merupakan penelitian deskriptif pada 39 pasien pasca stroke iskemik di usia produktif yang mendapatkan pemeriksaan lanjutan di Poli Syaraf RSUD Sidoarjo. Pengambilan data dilakukan dengan cara melakukan wawancara pada pasien pasca stroke iskemik di usia produktif pada bulan Januari-Februari Tahun 2017. Hasil dalam penelitian ini menunjukkan bahwa 62% memanfaatkan golden period penanganan stroke. Rata-rata kedatangan responden di rumah sakit pada 29,87±47,46 jam setelah terjadinya serangan stroke iskemik (range 1-168 jam). Responden yang datang ke rumah sakit terlambat atau >4,5 jam setelah serangan stroke dikarenakan sebagian besar responden tidak mengetahui tanda dan gejala penyakit stroke. Diharapkan rumah sakit atau tempat pelayanan kesehatan memberikan penyuluhan mengenai tanda gejala stroke pada pasien dan anggota keluarganya, serta pentingnya datang ke rumah sakit lebih awal setelah terjadi serangan stroke. Kata kunci: pemanfaatan golden period, stroke iskemik, usia produktif INTRODUCTION from permanent disabilities which possibly burden families and community. Whereas Stroke occurs because of damage in in developing countries, stroke cause at blood circulation in the brain, causing brain least nearly 6 million deaths each year tissue dead (Batticaca, 2008). Stroke (WHO, 2002). becomes the third deadliest disease in the world compared to heart disease and cancer. In Indonesia, stroke is the first cause Every year, 15 million people worldwide of most deaths in urban and rural areas. The suffer from a stroke. Among them, 5 million proportion of deaths due to stroke was people died, and another 5 million suffered 19.4% in urban areas and 16.1% in rural areas (MOH RI, 2008). The prevalence of ©2020 IJPH. License doi: 10.20473/ijph.vl15il.2020.258-265 Received 12 May 2017, received in revised form 28 June 2017, Accepted 30 July 2017, Published online: December 2020

Vidya Tri Huttami and Atik Choirul Hidajah, Utilization Of Golden Period... 259 stroke in Indonesia had increased from 8.3 hours after patients experience stroke per 1,000 people in 2007 to 12.1 per 1,000 (Hacke, W., et.al 2008). people in 2013. East Java province had the fourth highest stroke prevalence among Surveys in sever,al Asian countries other Indonesian provinces as many as 16 show that most patients in Indonesia were per 1,000 people (MOH RI, 2013) admitted late to the hospital. They mostly spend six hours to a week for hospital Based on the 2012 Health Profile of admission as they try alternative medicine East Java, stroke was among the ten most (Sutrisno, 2010). Whereas approximately common disease in patients under one-third of respondents were admitted to a outpatient and inpatient care at type-B hospital more than 24 hours after patients hospitals. For example, Sidoarjo District got stroke. The respondents were unaware General Hospital reported stroke became of mild stroke signs and symptoms. the top 10 causes of deaths in 2014-2015. In 2014, ischemic stroke was the fourth major By pointing out the stroke cause of deaths at the hospital with the prevalence in Indonesian community, this prevalence of 10.10%. Then in 2015, it study aimed to identify to which extent increased to 14.9% of deaths. patients use the golden period of ischemic stroke and to analyze causes of hospital Strokes can occur in any ages from admission among stroke patients. newborns to elderly. The disease incidence increases as people get older (Anies, 2006). METHODS In the past, stroke only affected elderly, but now this disease tends to increase in This study was descriptive and productive ages, even under the age of 45 collected data from January to February at years. The 2013 Basic Health Research the Neurology Clinic of Sidoarjo Hospital shows the prevalence of stroke in District in 2017. These study’s samples productive ages (15-64 years) was 62.6 per were 39 ischemic stroke respondents in 1,000 people. As stroke attacks young productive age (15-64 years) who could people in productive ages, they can have communicate well. lower productivity and family financial distress (Yulianto, 2011). These study’s variables involved patients’ characteristics (gender, age, Early patient admission to a hospital education, current occupation, family for patients who experience stroke signs and income, use of health insurance, and type of the quality of the initial treatment are health insurance), the number of stroke detrimental to the number of disabilities attacks, time span between stroke warning patients will have later. The golden period sign and the time of hospital admission, or golden hour is a certain period patients utilization of golden period of ischemic with stroke can use to decide an appropriate stroke, and factors affecting the utilization treatment. Medications carried out during of the golden period. the golden period can increase the likelihood of a stroke recovery (Adiati, T., The respondents wre then Wahjoepramono, 2010). The earlier interviewed to give further information. patietns are admitted to a hospital for Data obtained from the interview were treatment, the better the prognosisis, processed, analyzed descriptively, and thereby lowering the possibility of presented in a tabular or figure form. disabilities suffered later (Nadesul, 2011). Based on the European Cooperative Acute RESULTS Stroke Study (ECASS III), the golden period of administration of intravenous Respondents’ Characteristics thrombolysis therapy is less than 3-4.5 Respondents’ characteristics include gender, age, education, occupation, family income, use of health insurance, and

260 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:258-265 types of health insurance. The results show Based on age, the respondents in the that the respondents were mostly male age range 55-64 years were more dominant (53.8%). The number of male respondents (61.6%). There was no respondent aged 15- was not much different from that of female 24 years. Only one respondent was aged 32 respondents (46.2%). years, and one oldest respondent was 64 years old. Most respondents had elementary Table 1. Characteristics of Respondents at and junior high education (46.1%), while the Neurology Clinic of Sidoarjo only a few respondents had higher Hospital in 2016. education(18.0%). Characteristics n% This study further describes the respondents’ current employment status. Gender 21 53.8 Most respondents did not work after they Male 18 46.2 experienced stroke (43.6%). The majority Female of the respondents were in the high-income status (IDR 2,500,000-3,500,000) (51.3%). Age Most of them used health insurance issued by the government to get treatment from the 15-24 Years 00 hospital (79.5%). 25-34 Years 1 2.6 35-44 Years 4 10.2 45-54 Years 10 25.6 55-64 Years 24 61.6 Table 2. Number of Stroke Attacks. Education Number of n % Stroke Attacks Low (Elementary-Junior 18 46.1 1 time 36 92.3 2 times 2 5.1 High School) 14 35.9 3 times 1 2.6 Total 39 100 Intermediate (High 7 18.0 school) Higher (Bachelors) Occupation Housewife 12 30.8 Explained in Table 2, almost all respondents (92.3%) experienced stroke Unemployed 17 43.6 once. Civil servant/ soldier/ 1 2.6 police 3 7.7 Private worker 2 5.1 Time span between stroke attack and the time of hospital admission Entrepreneur 4 10.2 Retiree Family Income Table 3. Time span between stroke attack with time of hospital admission. Low (<1.5 million) 1 2.6 Medium (1.5-2.5 million) 11 28.2 Time of hospital n % High (2.5-3.5 million) 20 51.3 admission Very High (> 3.5 million) 7 17.9 <4.5 Hours Use of Health Insurance 1 Hour 10 25.6 2 Hours 8 20.5 No 8 20.5 3 Hours 6 15.4 Yes 31 79.5 Types of >4.5-48 Hours 6 15.4 Insurance 31 100 Government Health 0 0 3-4 Days 4 10.2 Private 5-6 Days 4 10.2 7-8 Days 1 2.6 Total 39 100

Vidya Tri Huttami and Atik Choirul Hidajah, Utilization Of Golden Period... 261 Table 3 presents most respondents Factors Percentage were admitted to the hospital in the first 1 (6.6%) hour of stroke attack (25.6%). The average Patients are not admission duration was 29.87 ± 47.46 hours 1 (6.6%) after the onset of stroke (range 1-168 hours). willing to be The longest hospital admission took about 7 15 (100%) days after the onset of a stroke. admitted to Utilization of Golden Period hospitals The utilization of stroke golden Patients get period can be observed from the time span between the time of stroke attack and and misdiagnosis at the admission of hospital admission. Respondents were considered using the first-level golden period if they were admitted to the hospital at ≤ 4.5 hours after experiencing healthcare facility the first stroke attack. Total In Table 4, this study presents 15 respondents did not use the stroke golden period for seeking the first treatment (60.0%) mostly because they could not identify the signs and symptoms. Not Utilized DISCUSSION Utilizin Golden Period Respondents’ Characteristics g… 62% As seen in Table 1, post-stroke Figure 1. Utilization of Stroke Golden patients participating in this study were Period mostly males (53.8%). Some studies show that men were more at risk of stroke Figure 1 shows that more than half compared to women (Wahyu, 2009). A man of the respondents utilized the golden has a 25% higher risk of having a stroke at period to get the first treatment as soon as a young age than a woman (Stroke possible (62%). Association, 2016). Factors causing the utilization of golden In line with this finding, the 2013 period Basic Health Research finds in Indonesia the prevalence of stroke in men was higher Patient admission outside the golden but not much different from women. Based period (4.5 hours only after ischemic stroke on the diagnosis of medical practitioners, attacks) did not use the time because of men have stroke prevalence of 7.1 per 1,000, some factors explained in Table 4. while women have that of 6.8 per 1,000. Similarly, Adawiyah, R., Kariasa, (2014) Table 4. Factors of Admission at >4.5 have found at Fatmawati Poli Neurology Hours. Hospital in Jakarta, the number of stroke male patients was more than that of females. Factors Percentage The higher incidence of stroke in men can 9 (60.0%) be caused by a higher unhealthy lifestyle, Patients cannot such as hypertension, smoking, and 4 (26.8%) drinking alcohol. identify stroke One of the risk factors for stroke is signs age (Sari, et al., 2016). In this study, the respondents mostly suffered from stroke in Nobody can the age range of 55-64 years (61.6%). In Indonesia, most stroke sufferers are in the accompany patients productive age group (Lumbantobing., 2007). Similarly, the 2013 Basic Health to hospitals

262 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:258-265 Research discovers an increase in the difficult to receive information and vice versa. prevalence of stroke along with increasing The results also show most age. The highest prevalence of stroke respondents with low education (61.1%) did not use the golden period of stroke to seek occurs at the age of 55-64 years. Age of 15- for treatment. It poses as the result of insufficient knowledge about stroke signs 24 years has stroke prevalence of 2.6 per and symptoms. 1,000, and age of25-34 years has prevalence In addition to education, the incidence of stroke also affects occupation. This study of 3.9 per 1,000. Additionally, age of 35-44 shows that most of the respondents did not work after experiencing stroke (43.6%). years had stroke prevalence of 6.4 per 1,000, Although all respondents were in productive age, the majority did not work. while people in the age group of 45-54 years Before the stroke attacked them, they still could work normally. Before the have stroke prevalence of 16.7 per 1,000. respondents got stroke, the majority of them had worked in private companies (10 Finally, those in the age group of 55-64 year respondents) and worked as entrepreneurs (4 respondents). However, they decided not tend to have stroke prevalence of 33.0 per to continue working as their health condition was not as fit as before. 1,000 people. Supporting this finding, Mahendra, B., The Basic health Research also shows and Rachmawati (2005) clarify disability is the most common effect of stroke limit each increase in age will cause a greater risk patients to move. In particular, strict regulations of some companies do not allow of having stroke. When people in the people with stroke to take leave from work or some people come home to seek for productive age suffer from stroke, it is someone who can take care of them. As a result, patients with stroke have more likely to result in economic distress on limitation in doing activities. families. Yulianto (2011) mentions people Most respondents with low education (61.1%) did not make use of the golden with stroke may have a decline in period of stroke for seeking a treatment due to lack of knowledge about the disease productivity and financial difficulties after symptoms. Immediate action in the golden period may reduce the impact or all. This is consistent with the results which complications of stroke. indicate almost half of the respondents Analyzed from health insurance status, people can utilize health insurance to (43.6%) did not work due to disabilities monitor their health status regularly just in case stroke attacks will recur. This study such as a paralysis. If the mortality and points out some respondents had recurrent strokes. Adawiyah, R andc Kariasa (2014) disability can be overcome, they might get also find the majority of post-stroke patients who continued treatment at the hospital back to work. To cope this problem, the experienced the first stroke (69.4%). government should have good, fast, and People should be alerted about recurring stroke since the attack might more appropriate stroke management (Lumbantobing., 2007). Education absolutely can bridge solutions for stroke management. This study find the respondents with stroke mostly had a low level of education (elementary-junior high school) (46.1%). Brillianti (2016) in her study also find that most post-stroke patients had elementary education. The lack of education can affect people’s lifestyle. Notoatmodjo (2007) further elaborates that people with more knowledge can shape better mindset and attitude, as well as behavior of healthy lifestyle. Lack of information about signs and symptoms will lead to susceptibility to various diseases, including stroke. Wardhani, N. R., and Martini, (2014)supports the finding by saying the learning process is influenced by education. People with low education will be more

Vidya Tri Huttami and Atik Choirul Hidajah, Utilization Of Golden Period... 263 fatal than the first attack. According to consequences that come up later. Lutfie, Pinzon, R and Laksmi, (2010), repeated (2012) said that fast and precise handling strokes in the first year were found in 11.2% during the golden period can prevent the of cases. Therefore, it is important to fatal effects of stroke. The longer people mitiage risk factors which can be a major ignore stroke, the greater the brain damage cause of recurring stroke, such as can occur. Quick treatment for stroke may controlling hypertension, cholesterol, and reduce 30% disabilities. smoking habits. Utilization of Golden Period of Stroke Time span between stroke attack and the time of hospital admission The utilization of the golden period of stroke can only be seen in people with Keeping us warned about stroke signs ischemic stroke. Based on Table 1, more will ease more rapid patient admission to than half of the respondents (62%) with hospitals to seek for the first treatment. ischemic stroke utilized the golden period to Table 3 shows most of the respondents were manage stroke signs and symptoms. The admitted in the first hour of stroke European Cooperative Acute Stroke Study attacks(25.6%), with an average duration of (ECASS III) mentions ischemic stroke 29.87 ± 47.46 hours. Not much different handling in the golden period takes less than from the research conducted by Saver, et al., 3-4.5 hours (Hacke, et al., 2008). (2010), there were 27.1% of patients admitted within 60 minutes after the onset Even though more than half of the of symptoms, but more than 70% admitted respondents were admitted within ≤4.5 outside the golden period. Such long patient hours, many patient admissions exceeds the admission can affect duration of drug golden period. As a result, they probably administration and treatment patient will did not receive this antithrombotic receive. treatment. Saver, et al., (2010) states brain damage result in nearly 2 million nerve cells Treatment of R-tPA (recombinant die. Decline in disabilities due to stroke may tissue plasminogen activator) for patients occur if patients are admitted to hospitals in with ischemic stroke is more effective if the golden period. Early treatment in the given in the first hour of stroke symptoms golden period can stabilize the condition of (Ebinger, et al., 2015). These anti- patients and prevent morbidity and thrombolytic drugs can destroy thrombus- mortality rates due to stroke. thrombus that clogs in the blood vessels of the brain (Mahendra, B & Rachmawati Factors causing delay in patient 2005). Not all patients admitted during the admission golden period can receive R-tPA treatment since they need to meet several criteria. It is likely to delay patient admission Research at 905 hospitals that are members when patients are not aware of stroke signs of the GWTG-Stroke (the Get With the and symptoms. This matter might be Guidelines) shows 28.3% respondents associated with insufficient knowledge of admitted in ≤60 minutes after the first stroke patients or their families. Therefore, attack, while 31.7% came in 61-180 families should be more aware of acting to minutes. The rest were admitted in > 180 get immediate help. In another minutes. It means only 64.7% patients circumstance, late patient admission admitted in ≤60 minutes received TPA occurred because of misdiagnosis. As a injection more than the others (Saver, et al., result, the respondents could not be 2010). immediately referred to get better treatment in more advanced health facility. Such Fast patient admission will the patient misdiagnosis indicates that the healthcare will have a greater chance of receiving facility did not apply quality control or antithrombotic drugs for reducing

264 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:258-265 improve quality of their services. Some stroke. Skripsi. Fakultas Ilmu healthcare providers are not capable of Keperawatan. Universitas Indonesia. giving treatment to patients because they Adiati, T., Wahjoepramono, E., 2010. 171 have limited facilities, equipment, or Tanya Jawab tentang stroke. personnel, thereby referring the patients to Jakarta: PT Gramedia. more advanced health facility. Anies., 2006. Waspada Ancaman Penyakit Tidak Menular, Solusi Pencegahan The respondents already used health dari Aspek Perilaku Dan insurance for accessing promotive, Lingkungan. Jakarta: PT. Elex preventive, curative, and rehabilitative Media Komputindo. treatments. Similar to the results of Association., S., 2016. State Of The Nation Misbach's, (2001) research, patients with Stroke Statistic. little knowledge of stroke signs and Batticaca, F., 2008. Asuhan Keperawatan symptoms had delayed admission to pada Klien dengan Gangguan hospitals. Some others still tried to find Sistem Persyarafan. Jakarta: traditional treatment for curing their disease, Salemba Medika. and some had transportation difficulties. Brillianti, P., 2016. Hubungan Self- Management dengan Kualitas CONCLUSION Hidup Pasien Pascastroke di Wilayah Puskesmas Pisangan More than half of the respondents Ciputat. Skripsi. Fakultas took advantage of the golden period to get Kedokteran dan Ilmu Kesehatan. first treatment at hospital. The majority of Universitas Islam Negeri Syarif respondents who were admitted late had Hidayatullah. poor knowledge of stroke signs and Indonesian Ministry of Health, 2008. Riset symptoms. Besides, they had nobody to Kesehatan Dasar 2007,. Jakarta. help them visit the hospital. Some still had Indonesian Ministry of Health, 2013. Riset difficulty in finding transportation, were not Kesehatan Dasar 2013,. Jakarta. willing to be treated at the hospital, and Ebinger, M., Kunz, A., Wendt, M., Rozanki, others got misdiagnosis that prolong M., Winter, B., Waldschmidt, C., et referral to more advanced healthcare al., 2015. Effects of golden hour facilities. thrombolysis: a Prehospital Acute Neurological Treatment and InIt is important that all family Optimization of Medical Care in members are aware of stroke signs and Stroke (PHANTOM-S) substudy. symptoms to act out just in case patients JAMA Neurology, 72(1), pp.25–30. experience stroke attacks. It is expected that hospitals, especially nerve polyclinics can https://doi.org/10.1001/jamaneurol.2 provide counseling about stroke signs and 014.3188 symptoms, as well as the utilization of the golden period in handling ischemic stroke Hacke, W., Kaste, M., Erich, B., Miroslav, and improve. First-level healthcare B., Antoni, D., Donata, G., et al., facilities should improve the quality of 2008. Thrombolysis with alteplase 3 examinations, working together with health to 4,5 hours after acute iskemik insurance agency, and provide training stroke. The New England Journal of about stroke for staff. Medicine, 59(13), pp.1313–1329. REFERENCE Lumbantobing., 2007. Stroke bencana peredaran darah di otak. Jakarta: Adawiyah, R., Kariasa, I.M., 2014. Faktor Badan Penerbit FK-UI. faktor yang berhubungan dengan kualitas hidup pada pasien pasca Lutfie, S.H., 2012. Kembali aktif pasca stroke, panduan terapi mandiri penderita stroke di rumah. Solo:

Vidya Tri Huttami and Atik Choirul Hidajah, Utilization Of Golden Period... 265 Metagraf. pengetahuan tentang stroke pada pekerja institusi pendidikan tinggi. Mahendra, B., Rachmawati, E., 2005. Atasi Jurnal Berkala Epidemiologi., 2(1), pp.13–23. Stroke dengan tanaman obat. WHO, 2002. The atlas of heart disease and stroke. Jakarta: Penebar Swadaya. Yulianto, A., 2011. Mengapa Stroke Menyerang Usia Muda?. Jakarta: Margaret, J.S., Loria, G., 2013. Early PT. Buku Kita. management of acute ischemic stroke cases (Acute Stroke Protocols & Guidelines/Algorithms) @ Apollo Hospitals, Hyderabad. Apollo Medicine IO. https://doi.org/10.1016/j.apme.2013. 11.002 Misbach, J., 2001. Pattern of hospitalized- stroke patients in ASEAN countries an ASNA stroke epidemiological study. Med J Indones, 10(1), pp.48– 56. https://doi.org/10.13181/mji.v10i1.6 Nadesul, H., n.d. Menyayangi Otak, menjaga kebugaran, mencegah penyakit, memilih makanan. Jakarta: Kompas. Notoatmodjo, S., 2007. Pendidikan dan Perilaku Kesehatan. Jakarta: PT Rineka Cipta. Pinzon, R., Laksmi, A., 2010. Awas Stroke!Pengertian, Gejala, Tindakan, Perawatan dan Pencegahan. Yogyakarta: Andi Offset. Sari, W., Lili, I., Catur, S., 2016. Care Your Self, Stroke cegah dan Obati Sendiri. Jakarta: Penebar Plus. Saver, JL., Eric, ES., Greg, C., Fonarow., Mathew, JR., Xin, Z., et al., 2010. The “golden hour” and acute brain ischemia presenting features and lytic therapy in >30.000 patients arriving within 60 minitus of stroke onset. AHA Journals., 41, pp.1431- 1439. https://doi.org/10.1161/STROKEAHA .110.583815 Sutrisno, A., 2010. Stroke?You Must Know Before You Get It!. Jakarta: PT Buana Printing. Wahyu, G.G., 2009. Stroke hanya menyerang orang tua?. Yogyakarta: PT. Bentang Pustaka. Wardhani, N. R., Martini, S., 2014. Faktor yang berhubungan dengan

THE RELATIONSHIP BETWEEN MOTHER’S OCCUPATION, ADEQUACY LEVELS OF ENERGY AND PROTEIN WITH INFANT’S NUTRITIONAL STATUS Dian Anita Nilawati1, Lailatul Muniroh1 1Department of Public Nutrition, Faculty of Public Health , Airlangga University, Surabaya, Indonesia Correspondence Address: Dian Anita Nilawati Email: [email protected] ABSTRACT Infant is one of vulnerable groups that have nutritional problems. High prevalence of nutritional problems could affect nutritional status that become an important concern. The determining factor of nutritional status includes nutritional intake and maternal occupation. The purpose of this study was to determine the relationship between maternal occupation and nutritional intake, with nutritional status of infants aged 6-12 months. This study used cross-sectional design, with nutrional status of infants as dependent variable; intake of the food energy sufficiency level and protein sufficiency level. Subject was selected by simple random sampling technique. The interview was conducted on 88 mothers of infants aged 6-12 months, which used questionnaire, form food recall 2x24 hours (breastfeeding and complementary feeeding), and anthropometric measurements (W/L index). Data analyzed used Spearman-Rank test and Coefficient Contingency. The results of this study showed that most of the infants had normal nutritional status (76,1%). Maternal occupation (p=0,025) had correlation with nutritional status. The food energy sufficiency level (p=0,047) had correlation with nutritional status and protein sufficiency level (p=0,016) had correlation with nutritional status. The conclusion of this study is infant who get the sufficiency level of energy and protein sufficiency level adequate has normal nutritional status. Wasting infant tend to have inadequate energy and protein intake. This study suggest mothers to give complementary feeding appropriately the quantity and according to the stage of giving food to infant. Keywords: maternal occupation, nutritional status of infant, the sufficiency level of energy, protein sufficiency level ABSTRAK Bayi merupakan salah satu kelompok yang rentan mengalami masalah gizi. Masih tingginya prevalensi masalah gizi yang dapat berdampak pada status gizi menjadi hal penting untuk diperhatikan. Faktor yang menjadi penyebab dari status gizi adalah pekerjaan ibu dan asupan gizi. Tujuan dari penelitian ini adalah untuk menganalisis hubungan antara pekerjaan ibu, tingkat kecukupan energi dan tingkat kecukupan protein dengan status gizi bayi umur 6-12 bulan. Penelitian dilaksanakan dengan rancangan cross sectional. Tehnik sampling menggunakan simple random sampling. Penelitian dengan wawancara dilakukan menggunakan kuesioner, form food recall 2x24 hours (ASI dan MP-ASI), dan pengukuran antropometri (BB/PB). Data diolah dengan uji analisis Spearman Rank dan Coefisien Contingensi. Hasil penelitian menunjukkan sebagian besar bayi mempunyai status gizi normal (76,1%). Hasil uji statistik didapatkan adanya hubungan pekerjaan ibu (p=0,025) dengan status gizi bayi, hubungan tingkat kecukupan energi (p=0,047) dengan status gizi bayi dan tingkat kecukupan protein (p=0,016) dengan status gizi bayi. Kesimpulan dari penelitian adalah bayi yang tingkat kecukupan energi dan tingkat kecukupan protein adekuat maka mempunyai status gizi normal. Tingkat kecukupan energi dan protein semakin inadekuat maka bayi cenderung akan berstatus gizi kurus. Penelitian ini merekomendasikan kepada ibu untuk memberikan MP-ASI secara tepat kuantitasnya dan sesuai tahapan dalam pemberian makanan ke bayi. Kata Kunci: pekerjaan ibu, status gizi bayi, tingkat kecukupan energi, tingkat kecukupan protein INTRODUCTION stunting, and wasting. Data obtained from UNICEF (2014) show that Indonesia has A problem in achieving the 37% of children suffering from stunting, Sustainable Development Goals (SDGs) is 12% suffering from wasting, and 12% malnutrition. Nutrition problems in being overweight. developing countries include underweight, ©2020 IJPH. License doi: 10.20473/ijph.vl15il.2020.266-275 Received 31 May 2017, received in revised form 11 June 2017, Accepted 15 July 2017, Published online: December 2020

Dian Anita Nilawati and Lailatul Muniroh, Relationship Of Mother Work... 267 Failed nutrition may lead to infant prevent obesity. Belfield and Kelly (2010) mortality. Paying attention to children’s explain that breastfeeding can increase the growth is one way to overcome this probability of healthy condition and problem. The pattern of infant feeding prevent obesity in infants. Giving should be concerned as their brain growth supplementary food too early results in reaches around 75%. In the first 1,000 days insufficient quality nutrients because of a child's life, exclusive breastfeeding for infants cannot get breastfeeding optimally. 6 months and providing quality and timely can also reduce the death rate of under two Nutritious food is the main capital million by 6% (National Development of growth for infants (Walyono, 2010). Planning Agency., 2010). Supplementary food should be given when an infant is 6 months old. Providing In Indonesia, infants usually suffer balanced nutritious supplementary food from undernutrition and over nutrition. supports optimal growth and development. Excess or lack of nutrient intake in infants If breastfeeding is insufficient or can affect the nutritional status and health supplementary food given do not meet the status. Nutritional problems can be nutritional needs of the body, infant will permanent and unrecoverable even though suffer from malnutrition (Kurniasih, et al.c, children meet their nutritional needs in the 2010). Insufficient nutritional intake that future (Adriani, 2012). causes malnutrition ultimately increases infant morbidity and mortality rate (Dietz, Nutritional status contributes to the 2008). quality of Human Resources (HR), especially in terms of intelligence, Infants are the most vulnerable to productivity, and creativity. Poor infant’s nutritional problems compared to other age nutritional status can inhibit physical, groups. They need food with high calories, mental, and cognitive growth. Factors that protein, various vitamins and minerals. cause nutritional problems in infants can be divided into two, namely direct and indirect Infancy is a part of the first two factors. Direct factors are related to food years of life known as the golden age in intake and infections, while indirect factors which infants experience very rapid growth are concerned about work, knowledge, care and development. Nutrition determines patterns, social condition, economic human health and well-being (Sari, 2010). condition, health services, etc. (Adriani, 2012). The 2013 Basic Health Research shows that 5.7% Indonesian toddlers suffer One of the indirect factors affecting from malnutrition, and 13.9%. Indonesian infant’s nutritional status is mother's toddlers suffer from malnutrition. The occupation. Working mothers do not have prevalence of malnutrition and enough time to pay attention to their undernourisment in children increased from infants’ adequacy level of food intake. If 2007 to 2013, while the prevalence of they do, infants can effectively improve underweight in toddlers was 6.8%. The their nutritional status (Kusumawati, 2014). prevalence of obesity in toddlers reached 11.9%. East Java province is one of the Moreover, inadequate breastfeeding provinces which has high nutritional is one of the direct factors for nutritional problems as indicated by the prevalence of problems in infants. The World Health underweight and obesity issues in 2015 at Organization (WHO) and the United 15.6% and 2.2%, respectively (Surabaya Nations International Children's District Health Office, 2015). Emergency Fund (UNICEF) have recommended that children get breastfed Surabaya city also has high for at least 6 months and Insiani Early prevalence of malnutrition. The prevalence Breastfeeding. In addition to improving of underweight and obesity in Surabaya city infants’ health, breastfeeding can also was 16.9% and 3.1%, respectively. Data collected in the working area of the

268 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:266-275 Tanjungsari Primary Healthcare Center in compared to those that followed the WHO- 2015 show according to Body Weight/Age MGRS standard. Data were collected index, 4.9%. toddlers were underweight. through questionnaire-based interview and While in Surabaya, 22.8% toddlers were 2x24 hour food recall form instead. underweight (Surabaya District Health Nutritional intake was calculated from the Office, 2015). The high prevalence of volume, energy, and protein of breast milk. underweight and obesity and other If infants drink breast milk for 15 minutes, malnutrition can be influenced by various they would get the volume as follows: factors including adequacy levels of energy and protein. Overviewing the nutritional ASI = 500 ml = y ml problems in infants, this study aimed to X analyze the relationship between mother’s employment, adequacy level of energy, and Breast milk energy = adequacy level of protein with the 500 ml/100ml x 67 Kkal= Z nutritional status of infants aged 6-12 months in the working area of Tanjungsari X Primary Healthcare Center, Surabaya. Breast milk protein = 500 ml/100ml x 1.2 g= t gram METHODS X This study used a cross-sectional Information : research design, in which data were collected at the same time and place X = the highest frequencies during the (Notoatmodjo, 2010). This research design study was done by identifying mother's work and measuring adequacy levels of energy and Furthermore, the volume, energy, protein that infants receivedTanjungsari and protein in the first day and so forth were Primary Healthcare Center. This study was totaled and averaged. The average conducted in the working area of consumption of energy and protein of Tanjungsari Primary Healthcare Center in breast milk was summed with energy and Surabaya from October 2016 to February protein intake of supplementary food. 2017. Then, the data of summed energy and protein intake were compared to the energy The research population was and protein adequacy standard. Data were mothers who had infants aged 6-12 months analyzed and presented in the forms of and lived in the working area of the frequency distribution, cross-tabulation, Tanjungsari Primary Healthcare Center in and percentages. To determine the Surabaya. The research sample was relationship between mother’s occupation selected using a simple random sampling and infant’s nutritional status, this study technique from the population that met the performed a contingency coefficient test. criteria. There were 88 mothers willing to Meanwhile, the Spearmen Rank test was beinvolved. Their infants should have no performed to find the relationship between LBW history and no birth defects. The adequacy levels of energy and protein with sampling frame was obtained from the baby infants’ nutritional status. This study has cohort book Tanjungsari Primary passed the ethical clearance with No: 13- Healthcare Centerprovided by the primary KEPK. healthcare center. RESULTS Measurement of infant’s nutrition status based on Body weight/body length Respondents’ Characteristics used a digital scale and length board. The results of the measurements were then Respondents in this study were 88 mothers who had infants aged 6-12 months and who lived in the working area of

Dian Anita Nilawati and Lailatul Muniroh, Relationship Of Mother Work... 269 Tanjungsari Primary Healthcare Center. Table 1 shows that most of the repsondents had female babies aged 12 months old. The rest had babied at least aged9 months old. Table 1. Frequency Distribution of Employed Infants’ Characteristics in the Unemployed 36% Working Area of Tanjungsari 64% Primary Healthcare Center, Surabaya, 2016. Independent Category n % Job Variable 6 months 10 11.4 Figure 1. Frequency Distribution of Mothers’ Characteristics by 7 months 10 11.4 Occupation. 8 months 10 11.4 Age 9 months 5 5.7 Table 2. Frequency Distribution of Mothers’ Characteristics in the 10 months 18 20.5 Working Area of the Tanjungsari 11 months 12 13.6 Primary Healthcare Center, 12 months 23 26.1 Gender Male 39 44.3 Independent Category n% Variable Female 49 55.7 79 83.3 Age 20-35 Mothers’ age was categorized into Years 9 10.2 age groups of <20 years, 20-35 years, and >35 Years 11 >35 years. Table 2 shows that most of the 78 99 mothers were in the age group of 20-35 Birth Distance Close 50 56.8 years (89.8%). These results indicate that they had been in early adulthood. The Sufficient 38 43.2 majority were 30 years old. This study categorized birth spacing into 2 groups: Infant feeding Breast close (<24 months) and enough birth Milk spacing (≥24 months or single/first child). No Breast Most of the mothers had spaced one birth Milk to another (98.9%); in other words, their infants had sufficient age difference. In Surabaya, 2016. terms of breastfeeding, most of the mosthers still breastfed infants during 6-12 Adequacy level of energy months. Adequacy level of energy was Mother's occupation categorized into two types. The infants were considered to have adequate energy Figure 1 shows that 63.6% of the intake if the adequacy level of energy was mothers did not work. In accordance with at ≥77% RDA. While inadequate level of the results of the interview, they worked as energy reached <77% RDA. private employees.

270 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:266-275 Table 3. Frequency Distribution of Table 4. Frequency Distribution of Adequacy Level of Energy in Adequacy Level of Protein in Infants Aged 6-12 Months in the Infants Aged 6-12 Months in the Working Area of the Tanjungsari Working Area of the Tanjungsari Primary Healthcare Center, Primary Healthcare Center, Surabaya, 2016. Surabaya, 2016. Nutritional status n % Nutritional status n % Very thin 0 0.0 69.3 Thin 7 8.0 Adequate 61 30.7 Normal 67 76.1 Fat 6 6.8 Inadequate 27 Very fat 3 3.4 Infant’s Nutritional Status Table 3 illustrates that the infants had adequate level of energy (69.3%). Infants’ nutritional status measurements were categorized into 5 Adequacy Level of Protein groups: very thin, thin, normal, fat, and very fat. Adequacy level of protein also used the same categories. Infants were Table 5. Distribution of Frequency of considered adequate protein if the adequacy Nutritional Status in Infants level of protein reached ≥ 77% RDA. Aged 6-12 Months based on Contrastly, those with the adequacy level of Body Weight/Body Leght protein at <77% RDA would be considered to have inadequate protein. Based on Table Nutritional status n % 4, this study explains most infants had 77.3 adequate levels of protein (77.3%). Adequate 7 22.7 Inadequate 67 This study presents that most of the infants had normal nutritional status (76.1%), but 8% of them were underweight Table 6. The relationship between Adequacy Levels of Energy and Protein Adequacy Levels with Nutritional Status of Infants Aged 6-12-Months in the Working Area of the Tanjungsari Primary Healthcare Center in Surabaya in 2016. Categorie Nutritional status s Variables Very thin Thin Normal Fat Very Fat Employed n% n% Mother's unemploy 5 12.6 n% n% n % 3 9.4 Accupation ed 2 3.6 6.3 2 3.6 Adequate 18 56.3 4 12.5 2 1.8 Adequacy 2 3.3 4 6.6 Level of Inadequate 49 87.5 2 3.6 1 Energy 5 18.5 1 3.7 47 77.0 5 8.2 3 4.9 20 74.1 1 3.7 0 0.0 Adequacy Adequate 3 4.4 52 76.5 6 8.8 3 4.4 4 5.9 20.0 15 75.0 0 0.0 0 0.0 1 5.0 Level of Inadequate 4 Protein

Dian Anita Nilawati and Lailatul Muniroh, Relationship Of Mother Work... 271 Table 7. The Relationship between Independent Variables and Nutritional Status of Infants Aged 6-12 Months in the Working Area of Tanjungsari Primary Healthcare Center, Surabaya in 2016. Variables p Notes r Mother's occupation 0.025 There is a 0.335 Adequacy level of energy 0.016 relationship 0.257 There is a relationship Adequacy level of protein There is a 0.247 relationship 0.020 Table 6 shows that infants with to not have much time to prepare food for adequate energy levels had a normal babies at the same time, and maternalhealth nutritional status (77%). Furthermore, those condition was not fully fit. Too close births, with adequate protein levels had a normal as a result, affect mothers’ psychological nutritional status as well (76.5%). However, condition which can hinder breast milk some babies had underweight status production (Soetjiningsih., 2016). although they had adequate energy levels. The results indicate that almost all In Table 7, the analysis shows there infants with normal nutritional status had was a weak relationship between adequacy adequate birth spacing (more than 24 level of energy and infant nutritional status months). The birth spacing is sufficient to (p= 0.016; r= 0.257). help parents formulate the optimal care for their children, for instance providing Moreover, adequacy level of proten nutritious food (Adriani, 2012). had a weak relationship with infants’ nutritional status (p= 0.02; r= 0.247). Hasnain, and Sophie, 2010) and (Umeta, et al., 2003) further support this DISCUSSION finding by stating that babies born more than 24 months after previous birth did not Respondents’ Characteristics experience nutritional problems. Research conducted by Candra (2013) also finds that Age is an indicator for determining babies with birth spacing of more than two individual’s productivity. Older people years were not at risk of nutritional compared to younger people have less problems because their parents took care of productivity due to the less fit physical them optimally and monitored their condition and health. Age will affect nutrition intake. parental roles in providing nutrition to infants. It can be seen from this study where Breast milk is a very important for most of the mothers were in the age of 20- infants because it provides infant’s 35 years. According to Mubarak (2012), nutritional needs and contains immune there will be physical and psychological substances that can enhance health. changes in older ages. Psychological or Breastfeeding for infants is highly mental aspects in older ages become more recommended because it can support the mature. The mothers had enough early stages of infant growth. knowledge and experience about giving nutrition for their infants. The results show that most infants were breastfed. Similarly, research by Too close births can interfere child's Ratnaningsih, (2011) explains there was a physical and mental growth. Mothers tend relationship between the period of breastfeeding and nutritional status of

272 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:266-275 infants aged 6-12 months in Demak babies minimum food intake until they are at the age of 6 months. When babies are regency. Giri, (2013) also discovers a older, they need more nutrients from supplementary food (MP-ASI). Baby’s relationship between exclusive digestive system requires an adaptation process to solid food unless they will be breastfeeding with nutritional status of prone to diarrhea due to imperfect digestion. So that breast milk must still be infants aged 6-24 months. given as an immune substance (Nur and Marissa, 2014). if babies are ready to digest The relationship between mother’s solid foods but not given supplementary occupation and infant’s nutritional food yet, they will delay the process of status development and growth (Barasi, 2007). Mother's occupation determines to The more adequate breastfeeding, the which extent mothers pay attention to their better the infant’s nutritional status. infants’ growth. Working mothers usually Supplementary food only adds more had little time to spendwith their infants, nutrients as a baby gets older. Nutrious food and thus they put less attention on their is required to produce energy, protein, and infant growth (Ariningsih, and Rachman, all nutrients that fit the baby's needs. As 2008). infancy physical and mental growth occurs very quickly, intelligence and agility are The results of this study indicate more visible. Failing to meet the needs will that most of the mothers were unemployed. affect poor nutritional status (Adriani, In fact, mother’s occupation had a 2012). relationship with infant’s nutritional status. This is in line with research conducted by The results show that most of the Sulistyorini and Rahayu (2009), who find a infants with adequate energy intake had relationship between mother’s occupation normal nutritional status. In other words, and infant’s nutritional status. In other adequacy level of energy had a relationship words, unemployed mothers had infants withinfant’s nutritional status (p= 0.016). with better nutritional status. Farhanah and Futher, Meipita, (2009) discovers a Naleena, (2012), also further elaborates that relationship between adequacy level of the occupational status of mothers could energy produced from supplementary food play an important role in determining child with the nutritional status of infants aged 6- feeding practices which can affect infant’s 12 months. health and nutritional status. It means unemployed mothers could feed children Afriyani's research (2016) also finds better according to the age of the baby. a significant relationship between nutrient Little time spent with babies will affect intake and wasting cases at Talang Betutu parental role. Poor parental role, therefore, Primary Healthcare Center in Palembang will affect nutrition intake for infants as city. Wasting is a type of malnutrition in babies still depend on their caregivers. which infant’s weight does not go right with the height or the z score of more than -2SD. The relationship between adequacy Wasting in children can disrupt child levels of energy and protein with infant’s growth and even lead to death. A child who nutrition status gets enough nutrient intake is less likely to experience wasting or nutritional problems. Giving supplementary food too early Ernawati's research (2009) finds a can increase allergic reactions as babies’ relationship between adequacy level of digestive tract is not perfect yet to process energy and child’s nutritional status as well. solid foods which result in an increased risk of infection and obesity (Barasi, 2007). The low energy intake may be due to several factors including the frequency of Good nutrition intake is inseparable from parental role in managing child feeding pattern. Breastmilk only gives

Dian Anita Nilawati and Lailatul Muniroh, Relationship Of Mother Work... 273 feeding and amount of foods, appetite, and Most of them breastfed their babies and had infectious diseases (Astari, 2005). It is also sufficient birth spacing. important to pay attention to the process of food preparation and food hygiene Their infants mostly had adequate (Soetjiningsih., 2016). energy and protein levels. This also was dealing with their nutritional status which Research by Meilyasari and this study finds normal. Isnawati, (2014) in Purwokerto shows that low energy and protein intake in infants was Mother's occupation had a related to nutritional problems. Lack of relationship with infants’ nutritional status. nutrition intake, especially energy and In the same way, adequacy levels of energy protein in the long term, can cause baby’s and protein were related to infants’ weight loss, susceptibility to infection, and nutritional status. growth and development problems (Dewey and Mayers, 2011). Mothers should give supplementary foos appropriate for infants’ age to support This finding is relevant to Ningrum's optimal growth and normal nutritional study (2004), which find that good status. It is recommended that working complementary feeding that fulfills babies’ mothers pay more attention to provide nutrient needs could reduce the occurrence nutritional supplementary food for their of less protein energy in infants in the babies Muktiharjo Kidul sub-district, Pedurungan district, Semarang city. Another previous REFERENCE study conducted by Setiani (2012) shows a relationship between the risk of infectious Adriani, M., 2012. Peranan Gizi dalam diseases and the nutritional status of infants Siklus Kehidupan. Jakarta : aged 6-12 months. Infants who had an infectious disease were twice more likely to Kencana. have poor nutritional status as the immune Afriyani, R., 2016. Faktor – Faktor Yang system did not defend children from infectious diseases. Mempengaruhi Kejadian Wasting Feeding style for children should be Pada Balita Usia 1-5 Tahun Di concerned to meet the nutrition intake, such as protein. Infants aged 6-12 months need Puskesmas Talang Betutu Kota not only breast milk but also supplementary food to fulfill higher nutrition needs Palembang. Jurnal Kesehatan., 7(1, (Istiany, A., 2014). April), pp.66–72. Like energy, protein with the right proportion is necessary in early https://doi.org/10.26630/jk.v7i1.120 growth. Insufficent nutrition intake will cause infection and even growth disorders Ariningsih, E., and Rachman, H.P.S., 2008. (Fitriana, 2013). Therefore, supplementary foods in addition to breast milk could Strategi Peningkatan Ketahanan provide protein intake for infants older than 6 months (Darmayanti, 2014). Pangan Rumah Tangga Rawan CONCLUSION Pangan. Analisis Kebijakan Pertanian., 6(3), pp.239–255. In summary, most of the mothers in the working area of Tanjungsari Primary Astari, L.D.A., Dwiriani, C.M., 2005. Healthcare Center in Surabaya were aged between 20-35 years and unemployed. Hubungan Karakteristik Keluarga, Pola Pengasuhan dan Kejadian Stunting Anak Usia 6-12 Bulan. Media Gizi dan Keluarga., 29(2), pp.40-46. National Development Planning Agency., 2010. Periode Emas pada 1000 Hari Pertama Kehidupan. Barasi, M.E., 2007. Ilmu Gizi. Jakarta : Erlangga. Belfield, C.R., Kelly, I.R., 2010. The Benefits of Breastfeeding Accros The Early Years of Childhood.

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THE RELATIONSHIP BETWEEN GENDER, HISTORY OF ANKLE SPRAIN, AND ANKLE STABILITY WITH ANKLE SPRAIN STATUS Zhafira Faruhasa Epidemiology Department, Faculty of Public Health, Airlangga University. Surabaya, Indonesia Correspondence Address: Zhafira Faruhasa Email: [email protected] ABSTRACT Injuries can occur as a result of various activities, which of them is a sport. In 2017, basketball was a sport that produced the highest prevalence of injury incidence in the United States at 15.77%. Athletes who have ankle sprain are 20-40% more likely to experience chronic ankle instability. This study analyzed the relationship between gender, history of ankle sprain, and ankle stability with ankle sprain status in basketball athletes of Universitas Airlangga Surabaya. This study was analytical-observational research using a cross-sectional design. The research population was basketball athletes who were members of the basketball club of Universitas Airlangga, and finally there were 23 respondents selected as the research samples. The sample selection used the accidental sampling technique. The results of chi-square test (α = 0.05) indicate that there was a relationship between the previous history of ankle sprain (p = 0.002; RR = 9.1) and ankle stability with ankle sprain status (p = 0.013; RR = 6.), but gender had no relationship with ankle sprain status (p = 0.435; RR = 1.6). It concludes that the history of ankle sprain injury and ankle stability were related to ankle sprain status, but gender was not related to it. Keywords: gender, history of ankle sprain, ankle stability, ankle sprain ABSTRAK Cedera dapat terjadi akibat dari berbagai aktivitas manusia, salah satunya adalah olahraga. Pada tahun 2017, Bola basket merupakan olahraga yang menghasilkan kejadian cedera tertinggi di Amerika Serikat dengan prevalensi sebesar 15,77%. Atlet yang mengalami pergelangan kaki terkilir memiliki kemungkinan sebesar 20- 40% untuk mengalami ketidakstabilan pergelangan kaki kronis. Penelitian ini bertujuan untuk mengetahui hubungan antara jenis kelamin, riwayat pergelangan kaki terkilir dan stabilitas pergelangan kaki dengan kejadian pergelangan kaki terkilir pada atlet bola basket Universitas Airlangga Surabaya. Jenis penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang. Populasi penelitian adalah atlet bola basket yang tergabung dalam Unit Kegiatan Mahasiswa (UKM) Bola Basket Universitas Airlangga Surabaya, dan terdapat 23 responden terpilih sebagai sampel. Pemilihan sampel menggunakan teknik sampling aksidental. Hasil uji chi-square (α = 0,05) menunjukkan bahwa terdapat hubungan antara riwayat pergelangan kaki terkilir sebelumnya (p = 0,002; RR = 9,1) dan stabilitas pergelangan kaki (p = 0,013 dan RR = 6,4) dengan kejadian pergelangan kaki terkilir, sedangkan jenis kelamin tidak berhubungan dengan kejadian pergelangan kaki terkilir(p = 0,435; RR = 1,6). Dapat disimpulkan terdapat hubungan antara riwayat pergelangan kaki terkilir sebelumnya dan stabilitas pergelangan kaki terkilir dengan kejadian pergelangan kaki terkilir, sedangkan tidak terdapat hubungan antara jenis kelamin dengan kejadian pergelangan kaki terkilir. Kata kunci: jenis kelamin, riwayat pergelangan kaki, stabilitas pergelangan kaki, pergelangan kaki terkilir. INTRODUCTION The national proportion of injuries in sports was 3.5%. East Java province has Injury is an incident caused by the same high proportion of sport injuries various activities, one of which is sports. as the national proportion (Indonesian Sport is an activity performed with Ministry of Health, 2013). Sports injuries conscious regular movements to increase can be caused by two factors: intrinsic body functions. Human do sports because factors and extrinsic factors. Intrinsic of achievement, recreation, health, and factors include the athlete's condition, such education (Giriwijoyo, 2017). as tissue structure, tissue weakness, body posture, activity level, lack of physical and ©2020 IJPH. License doi: 10.20473/ijph.vl15il.2020.276-285 Received 29 April 2019, received in revised form 28 May 2019, Accepted 5 July 2019, Published online: December 2020

Zhafira Faruhasa, Relationship Types Of Gelamin... 277 mental readiness, while extrinsic factors potential to cause injury. Ankle sprain can include sport activities, such as sports occur to atheletes when they are equipment, falls or exposure, and training practicing, competing, or after competing methods (Indonesian Ministy of Youth and (O’Connor et al., 2004). Sports, 2015). Further, Gordon et al., (2014) Sprains, strains, knee injuries, researched WNBA athletes (Women's Achilles tendon injuries, pain along the National Basketball Association) and shin, fractures, and dislocations are the NCAA (National Collegiate Athletic most common types of injuries in sports Association) in the United States. They (National Institute of Arthritis and have shown that 117 of 172 athletes Musculoskeletal and Skin Disease, 2004). (69.11%) reported having ankle sprain. Based on Fong et al., (2007), ankle sprain Another study conducted by Ito et al., was the most common type of injury in the (2015) shows that the most common Netherlands (73%), the United States injuries in Japanese basketball athletes (68.3%), and Hong Kong (33%). It is were legs and ankle sprain (24.8% in men estimated that about 3,140,132 ankle and 23.8% in women). This study finds the sprain injuries in the United States have highest proportion of ankle sprain occurred occurred to 1,461,379,599 people/year to the atheletes (58% in men and 64.4% in with an incidence rate of 2.15 per 1,000 women). In 2017, basketball resulted in people/year (Waterman et al., 2010). The the highest number of injuries in the sprain was the fourth-highest type of United States with the prevalence of injury in Indonesia in 2007 with a 15.77% (Consumer Product Safety prevalence of 20.9% (Indonesian Ministry Commission, 2017). of Health, 2007). In 2013, the incidence of sprain increased to become the second- According to Sarwack and Chyntia largest type of injury in Indonesia with a (2014), athletes who experience ankle proportion of 27.5% (Indonesian Ministry sprain have a 20-40% chance of of Health, 2013). experiencing chronic ankle instability. Ankle sprain can also cause a continuum The highest incidence of ankle of lifelong consequences such as disability sprain was found in team sports and field and decreased quality of life (Wikstrom, et matches, for example basketball (Fong et al., 2013). These long-term consequences al., 2007). About half of all ankle sprain include changes in gait, disability to incidents occurred due to athletic and withstand loads, and maintain a stable basketball activities (41.1%) (Waterman et support base (Hoch et al., 2016). al., 2010). To begin the research, this study The high prevalence of ankle aimed to determine the relationship sprain in basketball can largely be between gender, history of ankle sprain, attributed to the nature of the sport which and ankle stability with ankle sprain status involves rapid changes in direction, player in basketball athletes at Universitas contact, repetitive jumps, and landing Airlangga, Surabaya. activities. Research conducted by Tummala et al., (2018) shows that METHODS basketball players changed movements every 2.0 to 2.82 seconds and jumped up This study was an analytical- from 35 to 46 times per game. Basketball observational study using a cross-sectional is considered a limited-contact sport. research design. The population in this Running with explosive movements and study was basketball athletes who were changes in direction and fast speed is part members of the basketball club at of the basketball features. Extreme Universitas Airlangga Surabaya. Of the pressure on the body during play has the population, the sample was 23 respondents

278 The Indonesian Journal of Public Health, Vol 15, No 3 December 2020:276-285 selected using the accidental sampling and non-injury (FAAM score of less than technique. This study was conducted in 75%). March 2019 at GOR CAMPUS C Universitas Airlangga, Surabaya. The Data were analyzed using bivariate research dependent variable was ankle and multivariate analyses. Bivariate sprain status, while the independent analysis could determine the distribution variables were gender, history of ankle of variables in the form of cross-tabulation sprain, and ankle stability. using a computer application, while multivariate analysis could identify the The history of ankle sprain were relationship between the dependent injuries that the respondents experienced variable and the independent variables in the last 6 months since the study was using the chi-square test with a α-value of conducted. In the questionnaire, it asked 0.05. This study has obtained an ethical whether the respondents had ever or never approval from the Ethics Commission of the ankle sprain. Ankle stability was Faculty of Public Health Airlangga measured using a balance test so-callled a University No: 63/EA/KEPK/2019. single-leg stance test, where the respondents stood one foot with knees bent RESULTS at an angle of 90o forward, arms straight to the sides, and eyes open for 30 seconds. The distribution of respondents’ This test was carried out to both legs characteristics by gender alternately. The test results were considered positive if the athletes were The results show that the majority unable to test one or both legs (Trojian and of respondents were female as many as 14 McKeag, 2006). Ankle stability was people (51.9%), while there were only 9 categorized into 2 categories: good (if the male respondents (39.1%) (Table 1). test results were negative) and bad (if the test results were positive). Table 1. The Distribution of Respondents’s Characteristics Data on ankle sprain were obtained from the scale results of the Foot and by Gender. Ankle Measure (FAAM). The FAAM was an instrument that describes functional Gender Freque Pecentage limitations for ankle and foot disorders. ncy (%) The FAAM consisted of 29 questions Male 9 39.1 divided into 2 measurements: 21 questions Female 14 51.9 for daily activity measurement and 8 Total 23 100 questions for sports measurement. Sports measurement was used to investigate The distribution of respondents’ athletes or populations with high physical characteristics by history of ankle activities (Martin, 2003). Therefore, this sprain study only used the sport measurement. The total scores of this measurement Table 2. The Distribution of Respondents’ ranged from 0 to 32. The sum of the scores Characteristics by History of from all answers was then added up and Ankle Sprain. divided by the largest possible value. It was then multiplied by 100 to get a History of Freque Percentage percentage. The higher score obtained Ankle Sprain ncy (%) indicated better functional quality. Ankle Ever 10 43.5 sprain status was categorized into two: Never 13 56.5 injury (FAAM score of more than 75%) Total 23 100 The results indicate that 10 respondents who had suffered from ankle

Zhafira Faruhasa, Relationship Types Of Gelamin... 279 sprain (43.5%), while 13 respondents had Table 5 shows that the majority of no history of ankle sprain (56.5%) (Table respondents were women, but the 2). prevalence of ankle sprain status was greater in men (44.4%) than women The distribution of respondents’ (28.6%) despite the same number of characteristics by ankle stability people with injuries in both men and women. The chi-square test finds no This study finds that 12 relationship between gender and ankle respondents had good ankle stability sprain status with a p-value of 0.435 and (52.2%), while and 11 respondents had an RR value of 1.6, meaning male athletes poor ankle stability (47.8%) (Table 3). had a 1.6 times greater risk for ankle sprain than women. Table 3. The Distribution of Respondents’ Characteristics by Ankle The relationship between history of Stability. ankle sprain and ankle sprain Ankle Freque Percentage This study points out the most Stability ncy (%) respondents with ankle sprain status had Good 11 47.8 ever a history of ankle sprain beforehand Bad 12 52.2 (70%). It finds a relationship between a Total 23 100 history of injury and ankle sprain status with a p-value of 0.002 and a RR value of Ankle sprain status 9.1, meaning those with a history of ankle sprain had a 9 times greater risk for ankle The results show that only 8 sprain than those who never had such respondents had ankle sprain (34.8%), history. while the others did not suffer from ankle sprain (65.2%) (Table 4) The relationship between ankle stability and ankle sprain status Table 4. The Distribution of Ankle Sprain Status among Basketball In this study, most ankle sprain Athletes. occurred in basketball athletes who had poor ankle stability (58.3%). The chi- Ankle Sprain Freque Percentage square test reveals ankle stability had a Status ncy (%) relationship with ankle sprain status with a 8 34.8 p-value of 0.013 and an RR value of 6.4, Injury 15 65.2 indicating athletes with poor ankle stability Non-Injury 23 100 were 6 times more likely to suffer from Total ankle sprain injuries than those with good ankle stability. The relationship between gender and ankle sprain status Table 5. Analysis of the Relationship between Gender, History of Ankle Sprain and Ankle Stability with Ankle Sprain Status. Ankle Sprain Status Total n% Variable Yes No p RR 9 39.1 0.435 1.6 Gender n% n % 14 60.9 Male Female 4 44.4 5 55.6 4 28.6 10 71.4 Injury History